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Original Research (Original Article) 


Basmah Salim Al Afari et al, 2019;3(10):040–044.

International Journal of Medicine in Developing Countries

Knowledge and awareness about cervical carcinoma among women in Saudi Arabia

Basmah Salim Al Afari1*, Rana AbdulAzeem Al-Bassam1, Hanouf Thunayan Alotaibi1, Ola Abdullah Alotaibi2, Dana Tariq Alsuwaidan3, Musarrat Nafees4

Correspondence to: Basmah Salim Al afari

*Medical Intern, Department of Health Studies, Dar Al Uloom University, Riyadh, Saudi Arabia

Email: bsya94 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 17 July 2019 | Accepted: 21 July 2019


ABSTRACT

Background:

Cervical cancer is one of the most preventable neoplasia in females. It is the second most common cancer in females with 80% occurrence in the developing countries. It has been predicted that incidence of cervical cancer would increase in Saudi Arabia. This study aimed to assess the knowledge and awareness levels of women in Saudi Arabia about cervical carcinoma.


Methodology:

Total of 415 randomly selected women aged 20–35 years participated in the study in Riyadh, Saudi Arabia, in July 2018. The study was based on a self-administered closed-ended questionnaire consisting of 32 questions assessing the knowledge and awareness about cervical carcinoma.


Results:

About the general knowledge of cervical carcinoma, this study found that the mean of the general knowledge toward cervical carcinoma was low. The highest knowledge among women in Saudi Arabia was “Heard of cervical cancer” (94%), while the mean of lowest was “Had direct contact with the disease” (20%). Among participants, 51.8% knew that cervical cancer can be a terminal illness, and 26% knew that cervical cancer is associated with an infection.


Conclusion:

These results showed that the majority of the participant's general knowledge towards cervical carcinoma was low. The majority of cases heard about Pap smear although there was high knowledge among women in Saudi Arabia about the vaccine against cervical cancer that contains Human Papilloma virus. More studies and investigations in this field are recommended since cervical carcinoma is preventable when approached properly.


Keywords:

Cervical carcinoma, pap smear, cervical cancer, human papilloma virus.


Introduction

Cervical cancer is a slowly developing cancer, which starts as precancerous dysplasia [1].Carcinoma of the cervix is considered as the second most common cancer among women throughout the world, with 80% occurrence in the developing countries [2]. Cervical cancer is reported to be the third most common gynecological malignancy in Saudi females with an incidence rate of 1.9 cases per 100,000 women/year. The number of new cervical cancer cases was 152 cases per year, and 55 women die from cervical cancer per year. An intense increase in the incidence of cervical carcinoma in Saudi Arabia is predicted; the projected number of the recent cervical cancer cases and deaths by the year 2025 will be 309 and 117, respectively [3]. An estimated 1%–2% of women develop cervical intraepithelial neoplasia grade 2 and 3 (CIN 2 and 3) each year worldwide [4,5].

The Papanicolaou’s (PAP) smear test is a simple and effective screening test for cervical carcinoma to detect pre-invasive and invasive stages. This early stage detection of cervical cancer is preventable, treatable, and curable. This screening method is proven to reduce the incidence and mortality from cervical cancer, up to 80% [6].

Human papillomavirus (HPV) infection is well recognized as the main cause of cervical squamous intraepithelial lesions and invasive cervical carcinomas. From more than 100 types of HPV described, about 40 are known to infect the genital tract, and about 20 have been classified as oncogenic to humans [7]. With recent advances in epidemiological studies, coupled with contemporary progress in molecular biology findings, have established a strong causal association between infection by serotypes 16, and 18 of the sexually transmitted HPV and cervical cancer [8].

Other risk factors which have been proposed to cause cervical cancer are; cigarette smoking, use of oral contraceptives, low fiber diet, older age, family history of cervical cancer, immunodeficiency, herpes-simplex virus II. Risk factors related to sexual behavior are: first intercourse at an early age, having multiple partners, having partners who are involved in high-risk sexual activities. Treatment of Cervical cancer depends on the stage. Early-stage of the disease is treated effectively either by surgery or chemo-radiation, while the advancedstage is treated primarily with chemo-radiation [1].

Primary and secondary prevention means of cervical cancers reduce the chances of the disease, and no other type of cancer has such good prevention. The primary prevention is through HPV vaccine; secondary prevention is through cervical screening. The reason behind the deaths from cervical cancer is not the maliciousness of cancer itself; it is rather the diagnosis of the carcinoma at its late stages [2]. Early detection Screening and proper follow up for cervical cancer have been proven to reduce its incidence and mortality rate worldwide [9].


Subjects and Methods

This is a cross-sectional study conducted on a random sample of the population of Riyadh, Saudi Arabia in July 2018. A convenient sample size of 415 women with an age range of 20–35 years was invited to participate in the study.

The study was based on a self-administered closedended questionnaire consisting of 32 questions that were divided into three sections. The first section consisted of six questions was about demographic data, including the name of the institute and level of education in the university.

The second section was related to the general awareness about cervical carcinoma having six questions. The third section was about the risk factors related to cervical cancer. In the third section, questions were related to awareness about PAP smear as a screening test and HPV vaccine with reference to preventing the cervical carcinoma. A five-point Likert scale format was used for the responses.

The data were compiled, checked for completeness, and analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 22. Results of descriptive analysis of knowledge and awareness of cervical cancer, Pap smear, attitude, HPV, and vaccine were tabulated. The knowledge score represented the sum of the correct answers of the 26 questions in the second and third sections of the questionnaire. The value one was given for the correct answers, zero for wrong answers, and for “don’t know” responses. The cut-off for a poor knowledge score was set at values below 60% of the total score.


Results

The present study was comprised 415 individuals who lived in Saudi Arabia, the data were collected by using a structured questionnaire, the majority had nationality of Saudi 401 (96.6%), the participants were distributed equally according to the age group approximately (100) per age group, the greatest of the samples had Bachelor’s degree 303 (73.0%), furthermost 302 (72.8%) was Married, while 113 (27.2%) was single.

Four questions with different-level and measurement were analyzed to recognize the magnitude of the general knowledge towards cervical carcinoma among women in Saudi Arabia. The magnitude was 68% and above who scored as high knowledge and less than 68% had low knowledge. Additionally, it was used Pearson Chi-Square to determine the differences among women in Saudi Arabia toward Cervical Carcinoma.

The mean of the general knowledge toward cervical carcinoma was low (0.48 ± 0.22), range (0–1) (48%), the highest knowledge among women in Saudi Arabia was “Heard of cervical cancer” (0.94 ± 0.23), range (0–1) (94%), while the mean of lowest was “Had direct contact with the disease” (0.20 ± 0.40), range (0–1) (20%). The association of general knowledge was considered statistically significant (0.05) χ2 = 32.8 ↔ 9.4.1, p ≤ 0.05 ≥ 0.001), except the Cervical Cancer can be a terminal illness was χ2 = 0.40, p > 0.05 < 0.462) as shown in Figure 1.

Six questions with different-level and measurement were analyzed to recognize the magnitude of knowledge about the relationship between estimated risk factors and occurrence of the disease among women in Saudi Arabia. The magnitude was 68% and above who scored as having high knowledge, and less than 68% had low knowledge.

Figure 1. General knowledge about cervical carcinoma.

Additionally, Pearson Chi-Square was used to determine the difference among women in Saudi Arabia towards knowledge about the relationship between estimated risk factors and occurrence of the disease.

The mean of the knowledge about relationship between estimated risk factors and occurrence of disease was low (0.40 ± 0.11), range (0–1) (48%), the highest knowledge among women in Saudi Arabia was “HPV infection” (0.60 ± 0.23), range (0–1) (94%), while the mean of lowest was “Multiple pregnancies and child births” (0.10 ± 0.11), range (0–1) (10%). The knowledge about relationship between estimated risk factors and occurrence of disease was considered statistically significant (0.05) χ2 = 39.8 ↔ 29.0, p ≤ 0.05 ≥ 0.001, shown in Table 1.

Seven questions with different-level and measurement were analyzed to recognize the magnitude of knowledge of the Pap smear as a screening test among women in Saudi Arabia. The magnitude was 68% and above, who scored as high knowledge, and less than 68% had low knowledge. Additionally, Pearson Chi-Square was used to determine the differences among women in Saudi Arabia toward knowledge of the Pap smear as a screening test.

The mean of the knowledge of the Pap smear as a screening test was low (0.35 ± 0.11), range (0–1) (48%), the highest knowledge among women in Saudi Arabia was “Hear about Pap smear” (0.80 ± 0.40), range (0–1) (80%), while the mean of lowest was “Start doing Pap smear” (0.10 ± 0.31), range (0–1) (10%). Knowledge of the Pap smear as a screening test was considered statistically significant (0.05) χ2 = 24.2 ↔ 10.9, p ≤ 0.05 ≥ 0.001) as shown in Table 2.

Three questions with different-level and measurement were analyzed to recognize the magnitude of the general knowledge towards the HPV vaccine among women in Saudi Arabia. The magnitude was 68% and above, who scored high knowledge, and less than 68% had low knowledge. Additionally, Pearson Chi-Square was used to determine the differences among women in Saudi Arabia towards the HPV vaccine.

The mean of the knowledge towards the HPV vaccine was very low (0.06 ± 0.19), range (0–1) (6%). The highest knowledge among women in Saudi Arabia was “Vaccine against cervical cancer contains HPV” (0.08 ± 0.23), range (0–1) (8%), while the mean of lowest was “The vaccine is protective against genital warts” (0.20 ± 0.40), range (0–1) (20%). The association of Knowledge was considered statistically significant (0.05) χ2 = 7.9 ↔ 3.5, p ≤ 0.05 ≥ 0.001) (Figure 2).

Table 1. The magnitude of knowledge about the relationship between estimated risk factors and occurrence of disease.

Knowledge items Answer M SD χ2 p
Correct Wrong
n % n %
B1: Genetic factors 25 6.0 390 94.0 0.60 0.24 32.1 0.001
B2: HPV infection 34 8.2 381 91.8 0.80 0.28 29.0 0.001
B3: Multiple pregnancies and child births 5 1.2 410 98.8 0.10 0.11 39.5 0.001
B4: Miscarriage and abortions 4 1.0 411 99.0 0.20 0.10 39.9 0.001
B5: Long term use of contraceptives oral 29 7.0 386 93.0 0.70 0.26 30.7 0.001
B6: Pregnancy at young age 7 1.7 408 98.3 0.20 0.13 38.7 0.001
Mean of knowledge 0.40 0.11

Table 2. The magnitude knowledge of the Pap smear as a screening test.

Knowledge items Answer M SD χ2 p
Correct Wrong
n % n %
C1: Hear about Pap smear 332 80.0 83 20.0 0.80 0.40 17.3 0.001
C2: Know when to start doing Pap smear 185 44.6 230 55.4 0.45 0.50 23.7 0.001
C3: Start doing Pap smear 24 10.4 207 89.6 0.10 0.31 19.6 0.001
C4: Know how frequently Pap smear should be done 173 41.7 242 58.3 0.42 0.49 24.2 0.001
C5: Know the duration Pap smear should be done 51 25.0 153 75.0 0.25 0.43 10.9 0.001
C6: know when to stop doing Pap smear 53 12.8 362 87.2 0.13 0.33 11.7 0.001
C7: know indicators 35 41.2 50 58.8 0.41 0.50 16.5 0.001
Mean of general knowledge 0.35 0.24

A one-way analysis of variance was accompanied to discover whether the responders with numerous characteristics had varied levels of knowledge. There was a non-significant difference in knowledge between Nationalities (Saudi and Non-Saudi) (p = 0.913). Moreover, no statistically significant difference between the knowledge in age groups was found (p = 0.975).

In contrast, there was statistically significant difference in the knowledge between

Marital status [F (1, 413) = 4.15, p = 0.001] and education level [F (2, 412) = 9.21, p = 0.001].


Discussion

According to general knowledge about cervical carcinoma, this study found that the mean of general knowledge toward cervical carcinoma was low. The highest knowledge among women in Saudi Arabia was “Heard of cervical cancer” (94%), while the mean of lowest was “Had direct contact with the disease” (20%). Among participants, 51.8% knew that cervical cancer can be a terminal illness, and 26% knew that cervical cancer is associated with an infection. In the western region of Saudi Arabia, a cross-sectional descriptive study was performed in the Department of Obstetrics & Gynecology, Faculty of Medicine, King Abdul-Aziz University Hospital, Jeddah, which included 200 respondents; nearly, 44.5% of them believed that patients with cervical cancer had a good chance of being cured [10]. In contrast to the present results, a descriptive crosssectional study was conducted among women in Saudi Arabia which included 412 participants, it revealed that there was good awareness of cervical cancer and its risk factors among the surveyed women (78.6%) [11].

Figure 2. The magnitude of knowledge toward HPV vaccine.

A study was carried out among 740 Saudi males and females above the age of 16 years, majority of the participants (73.9%) had heard about cervical cancer, but most of them didn't know that it is a preventable disease (48.5%) [12]. In China, a study conducted among 388 women reported that overall, 52.6% of the women (204/388) had knowledge about cervical cancer, and only 36.1% of the women knew that cervical cancer could be cured if it is diagnosed early, this refers to low knowledge about cervical cancer [13]. Many studies conducted in Asian countries reported that 50%–85% of women were aware of cervical cancer [14,15]. Mulhim et al. conducted a study, which aimed to assess the knowledge, signs, symptoms, risk factors and vaccination about cervical cancer. The study concluded that there was an absence of awareness regarding risk factors, early signs and symptoms and prevention of cervical cancer [16].

The Pap smear test is the recent screening method, which is also highly cost-effective [17]. Regarding knowledge of the Pap smear as a screening test, it was found that 80% of cases had heard about Pap smear, 44.6% knew when to start doing Pap smear, 41.7% knew how frequently Pap smear should be done, 25% knew the duration in which Pap smear should be done, 12.8% knew when to stop doing Pap smear and the lowest was “start doing Pap smear” (10%). Another study showed that 67.6% of the respondents were aware of the cervical screening (Pap smear), however, only 16.8% had ever had the test. Most of those who were aware of the screening had got their information from the media or doctors [6]. Kim et al. [18] conducted a study in Chicago in a sample consisting of 159 Korean-American women, 40–69 years of age; 26% of the respondents had never heard before bout the Pap smear test. Only 34% of respondents reported having had a Pap smear for screening, while another 20.8% reported having had a Pap smear due to health problem. In Hail, KSA, another study reported that the knowledge of the study participants about Pap smear screening test was low, only 33.3% of women knew about cervical cancer screening [19].


Conclusion

The study results showed that the majority of the participant's general knowledge toward cervical carcinoma was low. The highest knowledge among women in Saudi Arabia was “Heard of cervical cancer.” The majority of cases heard about Pap smear. Regarding knowledge about the relationship between estimated risk factors and occurrence of the disease, this study reported that the highest knowledge among women in Saudi Arabia was “HPV infection” as a risk factor for the disease. Also, it was found that there was high knowledge among women in Saudi Arabia about the vaccine against cervical cancer which contains HPV.


List of Abbreviations

HPV Human papilloma virus
PAP Papanicolaou

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from the participants.


Ethical approval

This study has been approved by the institutional review board of Riyadh Elm university, with a registration number FRP/2018/211 on 10-07/2018


Author details

Basmah Salim Al Afari1, Rana AbdulAzeem Al-Bassam1, Hanouf Thunayan Alotaibi1, Ola Abdullah Alotaibi2, Dana Tariq Alsuwaidan3 , Musarrat Nafees4

  1. Medical Intern, Department of Health Studies, Dar Al Uloom University, Riyadh, Saudi Arabia
  2. Medical Intern, Qassim University, Buraydah, Saudi Arabia
  3. Third Year Medical Student, Al Faisal University, Riyadh, Saudi Arabia
  4. Department of Health Studies, Professor of Anatomy, Riyadh Elm University, Riyadh, Saudi Arabia

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How to Cite this Article
Pubmed Style

Afari BSA, Al-Bassam RA, Alotaibi HT, Alotaibi OA, Alsuwaidan DT, Nafees M. Knowledge and awareness about cervical carcinoma among women in Saudi Arabia. IJMDC. 2019; 3(10): 40-44. doi:10.24911/IJMDC.51-1561646708


Web Style

Afari BSA, Al-Bassam RA, Alotaibi HT, Alotaibi OA, Alsuwaidan DT, Nafees M. Knowledge and awareness about cervical carcinoma among women in Saudi Arabia. http://www.ijmdc.com/?mno=54472 [Access: October 18, 2019]. doi:10.24911/IJMDC.51-1561646708


AMA (American Medical Association) Style

Afari BSA, Al-Bassam RA, Alotaibi HT, Alotaibi OA, Alsuwaidan DT, Nafees M. Knowledge and awareness about cervical carcinoma among women in Saudi Arabia. IJMDC. 2019; 3(10): 40-44. doi:10.24911/IJMDC.51-1561646708



Vancouver/ICMJE Style

Afari BSA, Al-Bassam RA, Alotaibi HT, Alotaibi OA, Alsuwaidan DT, Nafees M. Knowledge and awareness about cervical carcinoma among women in Saudi Arabia. IJMDC. (2019), [cited October 18, 2019]; 3(10): 40-44. doi:10.24911/IJMDC.51-1561646708



Harvard Style

Afari, B. S. A., Al-Bassam, . R. A., Alotaibi, . H. T., Alotaibi, . O. A., Alsuwaidan, . D. T. & Nafees, . M. (2019) Knowledge and awareness about cervical carcinoma among women in Saudi Arabia. IJMDC, 3 (10), 40-44. doi:10.24911/IJMDC.51-1561646708



Turabian Style

Afari, Basmah Salem Al, Rana Abdulazeem Al-Bassam, Hanouf Thunayan Alotaibi, Ola Abdullah Alotaibi, Dana Tariq Alsuwaidan, and Musarrat Nafees. 2019. Knowledge and awareness about cervical carcinoma among women in Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 40-44. doi:10.24911/IJMDC.51-1561646708



Chicago Style

Afari, Basmah Salem Al, Rana Abdulazeem Al-Bassam, Hanouf Thunayan Alotaibi, Ola Abdullah Alotaibi, Dana Tariq Alsuwaidan, and Musarrat Nafees. "Knowledge and awareness about cervical carcinoma among women in Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 40-44. doi:10.24911/IJMDC.51-1561646708



MLA (The Modern Language Association) Style

Afari, Basmah Salem Al, Rana Abdulazeem Al-Bassam, Hanouf Thunayan Alotaibi, Ola Abdullah Alotaibi, Dana Tariq Alsuwaidan, and Musarrat Nafees. "Knowledge and awareness about cervical carcinoma among women in Saudi Arabia." International Journal of Medicine in Developing Countries 3.10 (2019), 40-44. Print. doi:10.24911/IJMDC.51-1561646708



APA (American Psychological Association) Style

Afari, B. S. A., Al-Bassam, . R. A., Alotaibi, . H. T., Alotaibi, . O. A., Alsuwaidan, . D. T. & Nafees, . M. (2019) Knowledge and awareness about cervical carcinoma among women in Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 40-44. doi:10.24911/IJMDC.51-1561646708